AUGUST 2022 | The Surgical Technologist | 363 Kostretzis et al. Kinematic Alignment Total Knee Revision bone loss or instability requiring hinge implant, for example (22/85 cases), were excluded from this study. This might explain our lower rerevision rate compared to other studies. Second, our study is limited by its small sample size (43 revision TKAs carried out by only one surgeon) and this might contribute to overlooking the increased risk for aseptic loosening and recurrent infection after revision surgery. However, it is a continuous series, and we believe that our cohort is representative of an academic center revision practice. Second, our study has a short mean follow-up (4 years), and longer follow-up studies are warranted to evaluate the long-term safety of this technique. Third, many patients that participated in our study were referred to us from different institutions and data regarding the primary surgery were not available to us. Therefore, because of the retrospective nature of this study, we could not measure the improvement in PROMs from primary surgery. We believe that this study, being the first of its kind, will spark the interest in the orthopedic community to use rKA for revision TKA, especially in the cases of early, non-wear-related unsuccessful MA TKAs. It is agreed that using precision tools like navigation or robot is the future way to go to perform such procedures. Navigation in the setting of rKA revisions has been used by the authors (PAV, MOK). While this technology helps to make accurate refresh cuts, the actual design of the cutting block made for primary TKA makes it difficult to stabilize in cases with significant metaphyseal bone loss. It also does not allow the surgeon to perform step cuts. In the near future, robotic surgery may prove to be an appealing option to facilitate rKA knee revisions once the appropriate software is available. Last, there is limited scientific evidence to define the acceptable lower limb alignment and joint line tilt limits and related implants orientations. Such evidence, supporting the universal use of KA in extreme anatomies, may allow removing rKA boundaries. Nevertheless, in the meanwhile, we believe that rKA is a safe and favorable new technique for TKA revision. CONCLUSION Although current revision TKA implants are not ideal for revision TKA performed with rKA; it is an appealing alternative to MA in the mid-term, especially in the cases of early, non-wearrelated unsuccessful MA TKAs. DATA AVAILABILITY STATEMENT The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. ETHICS STATEMENT The studies involving human participants were reviewed and approved by Comité d’éthique de la recherche CIUSSS de l’Estde-l’Île-de-Montréal. The patients/participants provided their written informed consent to participate in this study. All patients consent for inclusion of their case. AUTHOR CONTRIBUTIONS LK, GBR, SM, M-OK, and JB collected the data and wrote the manuscript. JB carried out the statistical analysis. P-AV was involved in the experimentation and surgery performance and performed the surgeries, designed the study, reviewed the article, and was responsible for manuscript submission. All authors have approved the final article. SUPPLEMENTARY MATERIAL The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fsurg. 2021.721379/full#supplementary-material REFERENCES 1. Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S. Projected increase in total knee arthroplasty in the United States – an alternative projection model. Osteoarthr Cartil. (2017) 25:1797–803. doi: 10.1016/j.joca.2017.07.022 2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. 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